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Trileptal vs Depakote
Introduction
For patients with epilepsy or bipolar disorder, certain drugs help stabilize mood swings and manage seizures by altering the concentrations of compounds in the brain. Trileptal and Depakote are two such antiepileptic drugs often prescribed for this purpose. Both have mood-stabilizing effects and can control seizure activity but they do so in different ways.
Trileptal, also known as oxcarbazepine, affects voltage-gated sodium channels in the brain to inhibit repetitive firing of neurons, thereby reducing excessive electrical signals that lead to seizures. It is also used off-label for treating bipolar disorder due its stabilizing effect on mood.
Depakote, on the other hand, is a combination of valproic acid and valproate sodium which works by increasing levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain that slows down neuronal activity. This helps prevent manic episodes associated with bipolar disorder and controls epileptic seizures.
Trileptal vs Depakote Side By Side
| Attribute | Trileptal | Depakote |
|---|---|---|
| Brand Name | Trileptal | Depakote |
| Contraindications | Should not be taken with MAOIs or if experiencing worsening mood, depression, or thoughts of suicide. | Should not be taken with MAOIs or if experiencing worsening mood, depression, or thoughts of suicide. |
| Cost | For brand name, around $400 for 60 tablets of 300 mg. For generic oxcarbazepine, costs average between $0.20 to $0.70 per day. | For brand name, about $230 for 30 capsules of 500 mg. For generic divalproex sodium, costs start as low as roughly $0.50/day to $1-$2/day. |
| Generic Name | Oxcarbazepine | Divalproex Sodium |
| Most Serious Side Effect | Low sodium levels (hyponatremia), allergic reactions, unusual thoughts or behavior, signs of depression or suicidal thoughts, rapid heart rate, abnormal vision changes. | Signs of liver problems, changes in mental status/mood swings, severe drowsiness/difficulty waking up, signs of severe allergic reactions. |
| Severe Drug Interactions | MAOIs | MAOIs |
| Typical Dose | 600-2400 mg/day, with 1200 mg/day being generally sufficient for most adults. | Starts at 250 mg/day, can be increased to 500 mg/day, divided into two doses. Maximum dose explored is 1000 mg/day. |
What is Trileptal?
Oxcarbazepine (the generic name for Trileptal) is an anticonvulsant or antiepileptic medication, which marked a significant step forward from the first generation of such drugs like phenytoin. It was first approved by the FDA in 2000. Trileptal works by decreasing nerve impulses that cause seizures and pain. It is prescribed for treating epilepsy and trigeminal neuralgia. Oxcarbazepine has a selective influence on voltage-gated sodium channels, stabilizing hyper-excited neuronal membranes, inhibiting repetitive neuronal firing, and diminishing propagation of synaptic impulses. This selectivity results in it having fewer side effects than other anticonvulsants with broader mechanisms of action.
On the other hand, Divalproex Sodium (Depakote) is also an anticonvulsant used to prevent migraine headaches as well as treat various types of seizure disorders; however its mechanism involves increasing levels of gamma-aminobutyric acid (GABA), a neurotransmitter that calms nerves in the brain.
What conditions is Trileptal approved to treat?
Trileptal is approved for the treatment of varying types of epilepsy:
- Partial seizures, also known as focal seizures
- Tonic-clonic seizures (formerly known as grand mal)
- Mixed seizure patterns or other partial or generalized seizures
Depakote, on the other hand, is used in treating:
- Mania associated with bipolar disorder
- Epilepsy including complex partial seizures and simple and complex absence seizures
- Prevention of migraine headaches
How does Trileptal help with these illnesses?
Trileptal works to manage epilepsy by decreasing the amount of abnormal electrical activity in the brain. It does this by blocking voltage-sensitive sodium channels, which stabilizes hyperexcited neural membranes, inhibits repetitive neuronal firing and decreases synaptic impulses. The result is a reduction in the frequency and intensity of seizures. Sodium channels are crucial for generating action potentials - an essential part of neurotransmission where neurons send signals throughout the body including those that control movement, cognition, sensory perception and mood regulation. People with certain types of epilepsy have too much electrical activity happening at once, leading to seizures. By reducing this excessive activity through its effect on sodium channels, Trileptal helps patients manage their condition and stabilize their neurological function.
What is Depakote?
Depakote, also known as divalproex sodium or valproic acid, is an anticonvulsant and mood-stabilizing drug that increases the amount of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that helps to slow down brain activity, which can be beneficial for patients suffering from seizures or bipolar disorder. Depakote was first approved by the FDA in 1983. Unlike Trileptal (oxcarbazepine), another anticonvulsant medication, Depakote does not primarily act on voltage-gated sodium channels but rather augments GABAergic transmission. Its different mechanism of action means its side-effect profile differs from those drugs like Trileptal, particularly in terms of weight gain and liver toxicity - common side effects associated with long-term use of Depakote. Despite these potential drawbacks, it can be more effective than "typical" antiepileptic drugs such as Trileptal for certain types of seizures and for preventing manic episodes in people with bipolar disorder.
What conditions is Depakote approved to treat?
Depakote is an approved medication for the management of several conditions:
- Complex partial seizures, which occur in a limited area of the brain
- Simple and complex absence seizures, characterized by sudden lapses in consciousness
- Manic episodes associated with bipolar disorder.
How does Depakote help with these illnesses?
Depakote, like Trileptal, is an antiepileptic drug (AED) that works by increasing the concentration of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain which helps to slow down nerve signals. An increase in GABA can help prevent seizures. In addition, Depakote also affects other neurotransmitters and exhibits multiple mechanisms of action which may contribute to its broader spectrum of efficacy in bipolar disorder and migraines as well. This makes it a diverse treatment option for patients with different neurological disorders. It's commonly prescribed when a patient has not responded optimally to other AEDs such as Trileptal or could be co-prescribed with them under certain circumstances.
How effective are both Trileptal and Depakote?
Both oxcarbazepine (Trileptal) and valproate (Depakote) are established anticonvulsants with proven efficacy in managing seizures, being approved by the FDA within just a few years of each other. Since they function via different mechanisms, they may be prescribed under varying circumstances. The effectiveness of oxcarbazepine and valproate in controlling seizures was directly compared in several double-blind clinical trials; both drugs showed similar efficacy in managing seizure symptoms alongside comparable safety profiles.
A 2005 review of meta-analysis reports on Trileptal demonstrated it effectively controls partial-onset seizures from the first week of treatment. Its side effect profile is generally more favourable than many older generation antiepileptic drugs, and it has been well-tolerated even among paediatric populations. This study reports that Trileptal has become one of the most widely prescribed new-generation antiepileptic drugs globally.
Comparatively, a comprehensive 2016 review indicated that Depakote seems to exhibit broad-spectrum efficacy not only against various types of epilepsy but also for bipolar disorder and migraines. However, due to its potential for significant side effects such as weight gain or teratogenicity, Depakote is often considered after other first-line treatments have failed or aren't suitable. Robust research data supports its use as monotherapy or adjunctive therapy for epilepsy management but confirms less evidence supporting standalone use for psychiatric disorders when compared with mood stabilisers like lithium. Nonetheless, because it works through multiple pharmacological pathways simultaneously, Depakote could be an optimal choice for patients who haven't responded well to single-mechanism treatments or need additional mood-stabilizing benefits.
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At what dose is Trileptal typically prescribed?
Oral dosages of Trileptal range from 600-2400 mg/day, but research suggests that a dosage of 1200 mg/day is generally sufficient for managing epilepsy in most adults. Children and adolescents may be started on a lower dose based on weight (about 8-10mg/kg). In both populations, the dosage can be increased after a few weeks if there is no adequate response. The maximum dosage that should not be exceeded under any circumstance is 2400 mg/day.
At what dose is Depakote typically prescribed?
Depakote treatment usually starts at a dosage of 250 mg/day. The dose can then be increased to 500 mg/day, divided into two doses, taken 12 hours apart. The maximum dose is 1000 mg/day divided into two doses of 500 mg each and spaced out every twelve hours, which may be explored if there's no significant response to the initial treatment after a couple of weeks. Always remember that medication adjustments should only be made under the guidance and supervision of your healthcare provider.
What are the most common side effects for Trileptal?
Similar to other medications, Trileptal and Depakote may cause side effects.
With Trileptal, some commonly experienced symptoms include:
- Dizziness
- Sleepiness/drowsiness or fatigue
- Double vision
- Nausea/vomiting
- Coordination problems
- Rash
On the other hand, Depakote's outcomes are slightly different with common side effects such as:
- Nausea/vomiting
- Dizziness
- Weight gain
- Tremor (unintentional trembling or shaking)
- Hair loss -Diarrhea.
It is always recommended to consult a healthcare provider if any of these symptoms persist or worsen.
Are there any potential serious side effects for Trileptal?
While both Trileptal and Depakote are medications used in the management of seizures, they do have different side effect profiles. With regards to Trileptal, some patients may experience:
- Low sodium levels (hyponatremia), which can lead to symptoms such as headache, confusion, slurred speech, severe weakness, vomiting and loss of coordination
- Allergic reactions including hives or swelling on your face or throat
- Unusual thoughts or behavior; signs of depression or suicidal thoughts
- Rapid heart rate with feelings like you might pass out
- Abnormal vision changes such as blurred vision or tunnel vision
On the other hand, with Depakote usage there could be:
- Signs of liver problems: nausea/vomiting that doesn't stop, loss of appetite, stomach pain on the upper right side, dark urine and yellowing skin/eyes
- Changes in mental status/mood swings: agitation/confusion/depression/thoughts about suicide
- Severe drowsiness/difficulty waking up from sleep
In case any of these effects persist or worsen immediately get medical help. It's crucial to remember that every individual reacts differently to medication hence always discuss potential risks/benefits with a healthcare professional before commencing treatment.
What are the most common side effects for Depakote?
Depakote, a widely used drug for seizure disorders and mood stabilization, can cause various side effects. These may include:
- Nausea or vomiting, sometimes severe enough to cause weight loss
- Sleep disturbances like insomnia or excessive sleepiness
- Digestive issues such as stomach pain, constipation, and decreased appetite
- Tremors in the hands or arms
- Blurred vision and ringing in the ears
- Fast heartbeat indicating potential heart issues
- Mental confusion, agitation or uncharacteristic hostility
- Skin reactions such as rash
- Frequent urination which might be indicative of high blood sugar levels -A range of discomfort from headaches to dizziness to joint pain
It's important that anyone taking Depakote monitor these possible symptoms closely and consult with their doctor if they experience any of them.
Are there any potential serious side effects for Depakote?
Depakote, despite its efficacy in treating various conditions like seizures and bipolar disorder, can potentially cause serious side effects. If you experience any of the following symptoms while on Depakote, it's crucial to seek medical attention as soon as possible:
- Signs of severe allergic reactions including hives or itching; fever or swollen glands; difficulty breathing; swelling in your face or throat; burning eyes and skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) causing blistering and peeling.
- New onset of worsened mood swings, panic attacks, hostility, irritability, aggressive behavior, impulsivity or restlessness which may be signs indicative of suicidal thoughts.
- Uncontrollable eye movements or sudden loss of consciousness which could indicate a seizure.
- Confusion states accompanied by unusual shifts in mood/behavior.
- Visual disturbances such as blurred vision/double vision/painful/red/swollen eyes/halos around lights - an indication possibly pointing towards optic neuropathy.
- Irregular heartbeats may denote cardiac arrhythmias requiring immediate medical intervention.
- Hyperactivity characterized by racing thoughts/increased energy/reckless behavior/extreme happiness/irritability/excessive talking/unusually decreased need for sleep might signify manic episodes.
Always consult with your healthcare provider if you notice any changes while taking Depakote.
Contraindications for Trileptal and Depakote?
Both Trileptal and Depakote, along with other anticonvulsant medications, may increase the risk of suicidal thoughts or behavior in some people. If you notice a worsening mood, increased depression or anxiety, or any changes in your behavior such as thoughts about harming yourself, it is imperative that you seek immediate medical attention.
Neither Trileptal nor Depakote should be taken if you are taking certain other medications including MAOIs (monoamine oxidase inhibitors), due to potential harmful interactions. Always inform your physician about all current medication usage; stopping an MAOI will require a period of roughly 14 days before beginning treatment with either Trileptal or Depakote to avoid dangerous side effects. As always, never adjust dosage or stop taking prescribed medication without first consulting your healthcare provider.
How much do Trileptal and Depakote cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Trileptal (300 mg) averages around $400, which works out to $13–26/day, depending on your dose.
- The cost for 30 capsules of Depakote (500 mg) is about $230, working out to approximately $7.65/day.
Thus, if you are in the higher dosage range for Trileptal (i.e., 900 mg/day or higher), then brand-name Depakote is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
As for their generic versions oxcarbazepine and divalproex sodium respectively,
- Oxcarbazepine (300 mg tablets) is available in packs ranging from 30 tablets and above with costs averaging between $0.20 to $.70 per day based on typical dosages of up to 1800mg per day.
- Divalproex Sodium comes in quantities starting at 30 up to hundreds of capsules/tablets with strength ranging from125mg -500mg. The cost to you starts as low as roughly $.50/day when buying larger pack sizes upfront but could easily reach up towards $$1-$2 /day depending upon your prescribed daily dosage.
Popularity of Trileptal and Depakote
Oxcarbazepine, available under the brand name Trileptal among others, was estimated to have been prescribed to about 1.5 million people in the US in 2020. Oxcarbazepine accounted for just over 24% of prescriptions for anticonvulsant medications used primarily as mood stabilizers. It's considered a "second-generation" antiepileptic drug and has been generally increasing in popularity since it was approved by the FDA in 2000.
On the other hand, Divalproex Sodium, better known by its brand name Depakote, was prescribed to approximately 2.9 million individuals within that same year in America alone. In terms of prescriptions for mood-stabilizing antiepileptics, Depakote accounts for just under 40%. The use of this medication has been fairly steady throughout recent years due to its effectiveness not only as an anti-seizure medication but also as a mood stabilizer and prophylactic treatment option for migraine headaches.
Conclusion
Both Trileptal (oxcarbazepine) and Depakote (divalproex sodium) are widely used in the management of seizures, backed by numerous clinical studies indicating their effectiveness compared to placebo treatments. At times, these drugs may be combined for enhanced effectivity; however, this is subject to careful consideration by a physician due to potential interactions and side effects.
Trileptal operates primarily through blocking voltage-sensitive sodium channels, while Depakote acts by increasing levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. This difference in mechanism often dictates when each drug should be prescribed. While both medications can be used as first-line treatment options for some types of seizures, Trileptal tends mainly to be used for partial seizures whereas Depakote is typically employed across various seizure types including absence and mixed seizure disorders.
Both Trileptal and Depakote come in generic form which represents significant cost savings especially for patients who must pay out-of-pocket. An adjustment period may also apply with both medicines where initial effects might not immediately appear evident.
The side effect profile between the two drugs shows similarities but varies slightly; generally well-tolerated though Trileptal has less tendency towards weight gain than Depakote. Patients on either medication should closely monitor any changes or adverse reactions - notably mood swings or worsening depression – seeking medical assistance promptly if such symptoms occur.
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Refrences
- Shiah, I.-S., Yatham, L. N., & Baker, G. B. (2000, July). Divalproex sodium increases plasma GABA levels in healthy volunteers. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00004850-200015040-00005
- Flesch, G. (2004). Overview of the Clinical Pharmacokinetics of Oxcarbazepine. Clinical Drug Investigation. Springer Science and Business Media LLC.http://doi.org/10.2165/00044011-200424040-00001